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HomeMy WebLinkAboutHENKINS BLK 1 LT 4n ki,* n s
Block 1
Lot A
#051-292-22
�00CPALIr.O,. MUNICIPALITY OF ANCHORAGE Rent , '
7 On-Site Water&Wastewater Program ..,,oSo f
\, PO Box 196650 4700 Elmore Road •
i
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
httpa/www.muni.org/onsite C
,. ,,,,) 1)( l),11:1ni, nt
9'1'CN0RPGF'
On-Site Wastewater Disposal System Permit
Permit Number: OSP181380 Effective Date: 11/5/2018
Work Type: Septic Upgrade Expiration Date: 11/5/2019
Tax Code Number: 05129222000
Site Legal Address: HENKINS BLK 1 LT 4 G:0755
Site Mailing Address: 16207 OLD GLENN HWY, Chugiak
Owner: JONES BRIAN N & MEGHAN E Lot Size in Sq Ft: 21344
Design Engineer: PETER A. STANLEY Total Bedrooms: 3
This permit is for the construction of:
El Disposal Field ❑ Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
1. The location of the 1968 crib is unknown. If, during construction, the crib is located, construction of the system
will stop and a design change submitted to On-Site for review and approval.
2. All ML soil to be removed. MOA approved filter sand to be used to level prior to the 2' sand filter.
//1
Received By: / Date: / /
Issued By: 1`r"" a , / / — *NW /// ./9
MUNICIPALITY OF ANCHORAGE
' \
, f
� r7
Development Services Department Phone: 907-343-7904
On-Site Water &Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-292-22-000 jj
Property owner(s) JONES BRIAN N & MEGHAN E Day phon�N�l) C( ll —bj()
Mailing address 16207 OLD GLENN HIGHWAY, CHUGIAK, AK 99567
Site address 16207 OLD GLENN HIGHWAY, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) HENKINS, BLOCK 1, LOT 4
Legal description (Township, Range&Section) 30, 15N, 1W
Lot Size 21,334 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(El all that apply)
Absorption Field 0 Initial ❑ Single Family (SF) E
(w/wo ADU)
Septic Tank ❑ Upgrade Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Field Orientation (15.65.21 OE_1.b) Distance: !'1At
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
J
Y
(Signature of properI o ner or authorized a4ent�:, T�,• ltr;.r (v ("ter •k"1''s
J
Permit/Rush Fees: 5'D .00 Waiver Fees: ( 55.00 Si'Date of Payment: • Date of Payment: D I 11
Receipt Number: 1I Receipt Number: 6)..-703
Permit No. OS jjgi 2 2 SD Waiver No. 05V igloo
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Peter A. Stahley, P.E. and PMP
Civil Engineer
10/31/2018
Municipality of Anchorage
Development Services Department—Onsite Water& Wastewater
4700 Elmoore Street
Anchorage,AK 99519
Subject: Henkins Subdivision, Block 1, Lot 4—Request For Replacement Drain Field Permit &
Waiver to 15.65.210E.1.b "Disposal Field Orientation"; Revised Narrative
(Original Dated 10/19/18)
The purpose of this letter is to request a permit for the construction of a replacement absorption
field for the subject property. The lot is developed and contains an existing three-bedroom
dwelling, currently served by a 1000 gallon septic tank, deep trench drainfield. The drainfield is
showing signs of failure, with reduced absorption rates and periodic backups. The septic tank has
been inspected from the surface and does not appear to have settled or caused issues with
existing conveyance pipe to/from the existing deep trench or residence.
1. Existing Conditions:The lot is served by the failing absorption field, installed in 1980, and
a septic tank installed in 2011. The lot is served by a private well, as are the adjacent lots.
2. Site Topography:The site is fairly flat, with minimal slope north to south, and limited
slope with a maximum of^3 to 5%from the back of the lot to the front.
3. Proposed Replacement:
a. Sizing: The proposed replacement absorption field is a bed system, with minimum
dimensions of 42.86' long at a 15' width. System sizing is based upon the use of a
2' filter layer of sand and an absorption rate of 0.7 GPD/SF. The percolation test
performed on 10/17/2018 showing a perc rate of 13.71 minutes/inch was limited
to a relatively thin ML layer, with a free draining gravel layer encountered below.
A filter sand system was chosen because deeper system types are constrained by
the GW layer while the starting invert is controlled by the existing septic tank
which limits the amount of useable existing native material available.Note: All
measurements were made to the nearest 1/16", although written in simplified
form (i.e. 8 %2" is written, instead of 8-8/16")
b. Design Calculations:
3 bedroom x 150 GPD=450 GPD; Filter Sand->0.7 GPD/SQ FT
15870 S.BIRCHWOOD LOOP ROAD,CHUGIAK AK
'f(201)931-6002 l:PSTAHLEY@GMAIL.COM
Disposal Area = 642.86 Sq. Ft. required; 642.86 SF/15'wide=42.86 LF
Use 43'(L)x 15'(W) Bed with 2'(D) Filter Sand layer.
Invert at 520.45 to allow ample gravity flow from septic and maintain separation
to deeper ML layer seeps. The reference elevation is called out as 524.5 on a
concrete slab, and all elevations are tied to this—see Sheet Cl.
c. Siting & Slopes:The replacement site is located parallel to the existing field and
outside the 10' of clearance required based on twice the existing systems
effective depth (which is 5'). No steep slopes are located nearby.
d. Field Orientation (WAIVER REQUESTED:) Note that due to site constraints
(existing field, trees, property lines, etc) the field is perpendicular to the contours
of the site, resulting in a drop of approximately 3' over the length of the field.
Based on the 38 year operational history of the existing field which operates in a
parallel orientation and review of site conditions, this siting will not negatively
impact the performance of the new field. This waiver would not negatively affect
adjoining properties and would allow replacement of the failing field in the
originally designated location without excessive vegetation clearing due to trees
and vegetation in the northeast portion of the site. Boring logs in the vicinity are
consistent and indicate soil conditions are not expected to change even as grade
falls away. The profile below shows the design elevation of the bed versus existing
grade, the ML layer, and seeps observed during the test hole process.
Lo°t s.Jcc {;<0 elcu on
Ews+,Aa 6rv. �•g
ate'
Wcf.l cK,Q e"`"
•
a'SAVO LAVER _. b071.14 cF Slq.615,
4 .5AftD.TO Si 4 S'
Lir
0"41 r 64
11'07, seers ,
!� Elcw�io� 518.44 •LI6 Lfetl St34
(5. .6 9(-0.1J�, cam:+ -to ..s+)
Gruphk-
ScAI
C a 4 8 16 ati
Figure: Profile of proposed system,scale as noted
4. Groundwater: No groundwater was encountered down to 18' below grade. Well and
drilling logs indicate groundwater is located 50'+ below surface.
5. Wells & Water Systems: No private wells are within 100' of the existing or newly
proposed absorption field. Similarly, the public water well on Lot 1A of the Henkins
subdivision is well outside the 200' of clearance required.
6. Surface Water & Drainage: There is no surface water within 100 feet of the proposed or
existing systems. Drainage will not impact the operation of the proposed system.
This proposed replacement system will not affect the future development of the surrounding or
existing lots. Should you have any questions or concerns, please contact me at 201-931-6002.
Sincerely,
% ° • 49TH
�\ • *4
• 49
p • PETER A.ST /
Or`
, • No.CE-103095 •��,-•
Peter A Stahley, P.E. & PMP 1l>>>�FES
Civil Engineer
Attachments:
Drawing Package (3 Sheets; Existing Conditions, Replacement Site Plan, Details)
Soils Log & Percolation Test Results
01
-0 _ - LHn \e fls G \ L 1 -_-_-
cc \ Existing
• General Notes \
NO ; System Elevations and Inverts 1. Field Conditions have
M - M POINT SURF ELEV INVERT
been determined by
I k Slab-SE Corner 524.5(Benchmark) n/a on-site review,
CO \, \ Bldg Clean Out 524.25 522.16 existingy
� g survey/as-built
O documentation, and
Septic Inlet 525.19 521.09 On-Site* 41 Muni
N 3 Septic Outlet 525.57 520.93 and Wastewater Water
I \ Post-Septic CO 526.16 520.92 documentation.
Locations may be
Monitor Tube 528.46 520.83 approximate UON.
4. 2. Existing Dwelling is 3
e I bedroom, requiring
Li ( E) 4111ie n k i n s 3 B l o c k 1 t 450 GPD disposal
site.
(Y 3. Site is generally flat,
D ; *- north to south, with
limited slope from
rear of lot to front.
3 4. Existing Deep Trench
I field is at 9.1' BG
Existing Concrete Slab. \ per records and
SE corner used as reference benchmark, monitoring tube.
at assumed elevation 524.5. 5. No groundwater
Inverts/elevations relative to this point. k' observed.
6. Percolation observed
O 0 Vit' 1��\\\\ at 13.71 MPI.
1c ( ) * W ��
ell E `� w�F�L A S >I` � 7. SE Corner of exterior
,; • ''1 ' i slab at garage used
��: i As. . t, as local benchmark,
���. . �N �� �r elevation 524.50'.
k •
w�~_ w - -n k' s B I o C 1 Lot 4 il fairr mar u j to
X11 �RrP�o 5. iW rbc* ::En
O• •1.11r00 MIca ESsti
\ y129 . 40 ... M
M
r- / \A QS `. • _ � —F� •
/ 10.]1.16
3 1 ' m t Gomm«G-
plt.w9..1.latlon/FiMrt Y�fo
10'x10', -
s ge _ .
Approximate locations of abandoned see•a•e •it Pe
and septic tank per 1968 Health Authority Inspection report. ‘N° Revision/Lew Data,
•11Location based on swing ties from building and abandoned well. _
No visible remnants as of 10/2018 review of site conditions. �\ �� P res..
- � S 5 Rr 30' Perc ' Peter A Stahley PE+PMP
\ / Ch BOX
Perc Test Test Radius 1 0
0
Yi
.5' •BGr Chugiak AK 99567
^ Perc Test
W---.....____________ W W II I I -e •I. (NOT USE, .
(I) with dual cleanouts 41 kit ..I
C *- ,....P..Ing..._
0 Deep Trench JONES - Replacement Dram Feld
:47, 16207 Old Glenn Hwy
-
M M e Drain Field (E) Chuglak <
-' ;,ns dock 1 Lot 57 aaska
C / Groundwater
Monitoring
CD
—
CD 5 tains no wells orTube F
4/ (to 18' BG)
01 septics Jones — Existing .r
C I Lots t s 5 a n d u s e d a s10'28'2018 C 1
+, 0 40 80Lel ( E --
•X I •
� •ngle property\ — — - E �°'
Feet
Lel
o Hens SII` 1 Let 4
; Henkirt�� Blo 1
System Elevations and Inverts General Not..
`
�I \� - . POINT SURF ELEV INVERT 1. BASIS OF DRAINFIELD
00 Slab-SE Corner 524.5(Benchmark) n/a DESIGN IS 13.71 MPI
11
Bldg Clean Out 524.25 522.16 SOIL, CONSISTING OF
SILTY SAND (ML) AT
N Septic Inlet 525.19 521.09 5'-8.5' BG,
9 Septic Outlet 525.57 520.93 REPLACED WITH
itFILTER SAND TO
Replacement Field 528.8 526(varies) 520.45 REDUCE FIELD
FOOTPRINT.
- . 2. NEW FIELD IS BED
CL
Existing Concrete Slab. TYPE, 43' MINIMUM
SE corner used as reference benchmark,7/ LENGTH, 1 . WIDTH.
at assumed elevation 524.5. 3. MAINTAIN MINIMUM
CLEARANCE OF 10'
LJJ Inverts/elevations relative to this point. w FROMEXISTING
Z
_
4. CONNECT TO
J +� J EXISTING SEPTIC
-4.00 USING "BULL RUN"
-Absorption Field Basis of Design: 13.71 mpi soil replaced with filtejisa''‘ _\‘'---
•
\� " DIVERTER VALVE AND
N 450 GPD (3 Bedroom) C4 0.7 GPD/Sq. Ft (Filter Sand) OF . . As�gl CLEANOUT ASSEMBLY
U00 450 GPD/0.7 = 642.85 Sq. Ft Required �, • , 5. PROVIDE CLEANOUTS
*s.:'
AT EACH END OF
Use 43'(L) x 15' (W) Bed Absorption Field • •�i NEW DRAIN FIELD.
4 6. PROVIDE MONITOR
�, % ,k`• �,/��, O TUBE IN DRAIN FIELD
/, w ,, PER AMC
r' �PH�E� • �, 15.65DRAIN.6
/ 11 00 P.S 95 0"0 7. MAINTAIN !EL
BED DRANFIELD, 15'x45 $ 'sr �� , �'\ . ,
Hnkins �OCk LOt q 3 PIP ® 5C , 8. SEEHEASHEET 3
_.'j '��� DETAILS.
AT ELEV 520.45 'W/ FILTER SAND 9. SEPTIC OUTLET
ppSEE DETAIL 2/C3 ELEVATION 520.93,
FIELD VERIFY (,-4.75'
BG)
`... 4-411 • -49 I -I • 0 Ve•etated
,�•� Areas O�
'\`
1 .P.rmR Comments— 10.31.1E
. . �-•
i /
O ♦�10'x10.
Seepage' • / —.,� •�: \`' \Mo. Revision/Issue Date,
A••roximate locations of abandoned see•a•e •it -it
@• tank per 1968 Health Authority Inspection report. xi ti ,sa % 4" MONETOR Peter a tahley PE+PMP
ed on swing ties from building and abandoned well. -ptic Taf.
TUBE. PO BOX
z - Sheet Note ` Chugiak AK 99567
remnants as of 10/2018 review of site conditions. ��
--' ` - •' Per
Perc Tet 12' Test '•dius
rhynt Nom ad Mama
i
OR E L) -4111117/
PROPS'TY L E) JONES — Reii ‘
placement Drain Fel
AK
�/ _ W A 16207 Old Glenn Hwy
1111
ChuAl _ . _
DOUG E CLEANOUT I \NEW I,ti�
O= Alaska k
SEE DET IL C3 �.
Z , _
XISTI ,,,.
U -..:.. D R A T I E LD NEw syEten, site plan
M - M 40 " TO MAI "10/28/2018 C 2
C3 N
a � IW—
- s :I -et � '• = 20 J
N >,— //-----
IY (n (n
-0 i
DO Vi t 1(t�a I lit Yr Material Specificationsper Henk\115 i k L+ 9, 4" TOPSOIL \
N -F /% /� I'�/ 'WATER-TiOHT p --. AND SEEDING _ General Note.
0 � /; ACCESS CAP AMC 15.65 and Notes, / ��/./.I./. , ,././.; �. r
• �/ `��`�/I�/I/!\`�/`�/��\ �`%,$Q�j`�:' 1. Field Conditions
RISER c,� 1 . All pipe t0 be 4 I.D. ////N.-A� „,,� ,�, , „NAS• -/t##-
N. / have been
ADAPTER
2. Cleanouts and Monitor determined by
CO RISER / on—site review and
TUBE Tubes require / existing
0 VALVE DIRECTION watertight cap
9 PIPE BEDDING, NFS survey/as-built
N "ArDLE 3. Leach Field Selection BACKFILL WITH documentation.
?? rOUTPORr „ 2. Site is generally
Valve to be BULL NATIVE MATERIAL flat, north to
r otrrPORr �� PIPE ELEVATION PER PLAN south,
fromn rear limited
�� RUN" or equal. �,�� �,'� : lot to front.
' -'-'..' .- '4'1119' • , ..;too a••airkato•{iv
2" MIN / 3. Existing Deep
Q r IN PORT 414, -404(0.4•
Z 0 Trench field is at
• toe O Z 9.1' BG per records
I� � • fV � and monitoring
LL_I 3 ., LL U \ VALVE 'Mit.
,��S ��. 4" PVC PIPE E tube.
'•i ll• ifilkt ' CL m 4 observed.No groundwater
C3 NOT TO SCALE ! i �• ���••� „
5. Percolation
�'I_•'�IL� �• �_I•i��I•. 4 MIN observed at 13.71
MOUND 6" MINIMUM / I ; ,i MPI, Replace with
ABOVE ADJACENT // / filter sand..
0 GRADE, REMOVE AND REPLACE 6. Installation shall be
PROVIDE 4" MINIMUM UNSUITABLE MATERIAL, in accordance with
TOPSOIL THEN SEED. Muni Code 15.65,
COMPACT/PROOF ROLL Part I and Part II.
-- 6" — --_ 6" 7. All material and
-11=11=11.„ „11-11-11..-11.-11.,-,.11,,. _,;.111-,.IL-11,,-.11,-,.1111-,.111-,.11-,.111-,.111-,.II„-.11,-,.11„-.IL-,.11,-,.11.,-,.11.,-,.11.,-,_ - components shall
1'=11-11.=11=11=[-i=II=11=11=II=1I=11=i= =11=11=11=11=11=11=11.=11=11=11=11-11=11-11-11=11=11-11: : be in accordance
11=II=11=II=II=II=11=11 11. .11 11-11-11-11-11-11-11-II-I1-11-11-11-1I-I1-11-I1-1I-II-11-11=1I=II-11 with Municipality of
-11711-11-171711711711711-11-11-11-11-111-11-11-11-11-1111-11-11-11-11-11-11-11-11-11711-11-11'
BACKFILL WITH CLEAN 1 S EW E P I E DETAIL Anchorage On-Site
CO NATIVE MATERIAL, Water &
Wastewater
U' • OF C3 FIELD SEPTIC TO FIELD, NTS Program
O 15' BED WIDTH COVER, 2' ALLOWABLE "Standards and
WITH INSULATION Specifications for
REQUIRED Component Parts
and Materials” -
1'r) NATIVE MATERIAL, February 2011.
\ _ SCARIFY IF
0 SMEARED DURING 5' O.C. Perforated 2.5' to
N— CONSTRUCTION Distribution Pipes edge of field 2" MIN ABOVE
"�O� ALAS'�\\A I Chat*to Bed /F1t Satd 10.31.,9
4 11
.�/••'' •.OW( •.'' •.,' ••I' �.''_=.,'_=.,'_=.I'_` _=,'' .,' ,'' ,- ; , �P,G• • • • ,-- • -4, `NoRevision/haw Mei
a, a, a, a, a, a, a, a, ` a, a' a, rA. 1 •)'�'�'� '�'�'�r ' ' ' �'�'�' / 4" PERF PIPE j '!N �f1/4 • �,
1 1 11 1 1 .4•44•44.14.•. 1 ` lr1 1 1 1 ► 1' �' �' rinvert elev. 520.45 / Arm Mom obi Maws
Peter A Stapley PE+PMP
Up
a a a t a a . a a a /'s'o s .: ;•;'; .;. •;A: --I��of :�sly * Ii e 'cc/ P O BOX
I, / 6- SEWER GRAVEL �—� %o Chugiak AK 99567
t, t, t1 tAt t, ., t tAt t1 tiktA ttit / t/ ♦,r , BELOW PIPE
• a •a •a a a a a a a a a a a a a a a a 1
Q D N D N N D D N N N N N N N 1r ' CO3/o95•kir
W /N N N N N N N N N N N N N N FILTER SAND +its/. SO it ()§,,i.
0 Z C. C. C. C. I> C. C. C. C. N N N N N N N N N N 2' MINIMUM \`RfD FROFE S "°""'.i""'
N N N N N N N N N N N N _ i �"NN�� 16207 - Replace eennt Drain Fie!
Z N NN NN NN NN NN NN NN NN NN NN NN -› NN Hwy
Chugiakld
0 D N N N N N N N N N N N N N Alaska
N „ N N N N „ N „ N „ N „ N „ N „ N „ N N I i/�%ii/�%i iii iA e..
Cr_. Jones - Existing
cn i2 A3SOPTIO \ FIELD — 3ED TYPE — SECTION A\ D PROFILE _ 10 ,31,18 , C3
z . As Noted
O \ \C3 NOT TO SCALE
OF AL4 ,,`11
Municipality of Anchorage �P. NGINEER'S )]1
•
•
Development Services Department .0 • `�� • rr
Building Safety Division * 4
4 9TH �� .* f!
• . 7 y.r On-Site Water and Wastewater Program
I , 4700 Elmore Road /- •- : 0 /
P.O.Box 196650 Anchorage,AK 99507 / �-1 4�. /
www.ci.anchoraae.ak.us / /� ' �'
(907)343-7904 t � •
. PET R ..STAHLEYv7F
r �'�S, • No. CE-103095 +`(` :
Soils Log - Percolation Test �R • . . •• •�
i •F �_�
1lFap OF^S \C'-7-
Performed For: H t Ctla e ( •3 ovi r'.s Date Performed: f�} 1G)//•
Legal Description: /lei)kin S gab, .�` zo f Township,Range,Section: 301 K iJ l,V ./ ,
Slope 'Site Plan 1,[ e c•
cff.
4,y)
`Depth IrrSFeet)
-_e, Tc So;I4'
1-�` . 7gxed070.01'6
2- GGA wtll- ,:<utcicp."I/ a
+
� aft4c 4. , \c, � �)y �4- .f.- G w/ �: v �„N O'iii....-_____i
ICS il'i Wil. fnSGnd, �QV�t=
!
- 41I11r ltfill (O Abra✓YjcSfi
i3 ;t17- ^ m 6
e,651:,- c'cQd 608- +,
Tcs4 � WAS GROUND WATER A / d
of C0 44 9- rOArSe4' ,/l ENCOUNTERED? /V�L� S� �T�� Willi ���
1s '
S� _' ' j r
��' �; �t -/SG�t IF YES,AT WHAT DEPTH? �� /G.` 05 jy
(- (7V1 Depth to Water After /
1</ Q�? Monitoring? MAC E i.'-
11-
12- :.V 6/Afti Date: 10/l.7./... .4
5
0 t(°S. L LAI
Ql.k�14461')13- i� tii,_ Sunr�6,,,d
F-'1! 14 . a+w Reading Date Gross Time Net Time''"•1 Depth to Water Net Drop
or $ii-stif i 15- . ,1 .4 t-dz t SivA- (0/I 0 3' (IS" 0
,....4.,16 I ML i S.6tAcLs-S;14" %r LI t 15 r'+'' 4 30 10 "(re) 6l`t, ,y
•
17- ' 1 i; CH-
5 i0 LP-Ad, ). If U+ PC't t6� ': '" ti 0i
to "[
18 wt �j 3 S...3�.P"' f IC. ?-'' 3��
e1ke)(,7 19- l Li 'r c plti 4 - y /' //
ie vsLxi. m�riv.ti G� �6 /Lit �: f} .S
PM
20-
It me-11,0c, 3 6r6 I//, & its
t r -9•:O61.+1 1:.01 6 vti , , yii
PERCOLATION RATE I Z, ?-I (minutes/inch) PERC HOLE DIAMETER G f�- .7 ', (0/*AS
TEST RUN BETWEEN �� C� FT AND FT
COMMENTS T / n `,
/ � Test ,) ‘,.icu run (J� C�'.S -�� 10 t?. �•. (r,•nf;,.��U r��ii i.. . ("cr.(�.ti`;
te't^',: ,, 1-;i.flair (writ vr,tln^ a Ors/ tigx((t-+r ihct'orb-:,, /lea
PERFORMED BY: F frc' A , S -al,1t, 'c, 1 t ! ,e CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE ANLMUNICIPAL GUIDELINES IN EFFECt,OP HIS DATE. DATE: (`)/l�� .)L:�(�%
l
e Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650 Pagel of 2
www.cLanchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWSW111126 PID Number: 051-. ;k- �-
Name:
Wastewater System: ❑ New ® Upgrade
Atltlress:
ABSORPTION FIELD
Phone:-8720 Number of Betlrooms:
D Deep Trench ❑ Shallow Trench ❑ Bed 0 Mound D Other:
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
Block Lot: Subdivision:
Depth to pipe bottom from original pace:
Gravel depth beneath pipe:
Henkins
Ft
t.
Township: Range: Section:
Fill added above original grade:
Gravel Length:
Ft.
Ft.
Well: ❑ New ❑ Upgrade
Gravel width:
Number of lines:
Distance between Imes:
Ft.
Ft.
Classification (Private, A, B, C):
Total Depth:
Cased to:
Total absorption area:
Pipe Material:
Exisfig Private
Ft.
FL
Fe
1 3034
Driller:
Date Drilled:
Static Water Level:
Installer:
Date Installed:
Ft.
Flintstone Const
1 7/29/2011
Yield
J Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
ublicJPrivate
Manufacturer:
Capacity.
From
Tank
Field
Station
Tank
Seveer Line
Anchors a Tank
1000 Gel.
Well
129.4
---
---
---
Material:
Number of Compartments:
Steel
2
Surfaceweter
100+
LIFT STATION
11
Size:
Manufacturer.
Lot Line
Gal.
Foundation
73
'Pump on' level at
'Pump ofr level at
High water alar at:
in.
in.
in.
Curtain Drain
50+
7
Pump Make & Model
Electrical Inspections performed! by:
Ramarka:
Existin tank removed and disposed of per code.
BENCH MARK
Location and Description:
House FF
Assumed Elevation:
100.0 Ft.
Engineer's Stamp
•• OF q '�
Inspections performed by: PES. LLC Dates: 1x'7/29/2011
TH
49—
2n07129/2011
.....7. .... .........d.....�
A
Development Services Department approval
P P PP
'
j. ;Steven R. Pannone Ar
Conditional Approval by: Date:
��j�♦.,N��bIB 149
's'
/
Reviewed and approved by: Date: I - l a- /
�44FESS,�6k
et,
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ss
T1
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5
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LOT UNDEVELOPED
NO WELLS OR
\SEPTICS
2/\
WELL (E)
NOTES:
RECORD DRAWING
PLAN
/ �W�_W
EXISTING
SEPTIC AREA
1000g SEPTIC TANK: (P) EXISTING
AND DOUBLE CLEAN O�M SEPTIC AREA
COLLAPSED I OOOg SEPTIC TANK (E)
ABANDON PER CODE
DRAIN FIELD (E) 16
�MT
WELL (E)
SWING TIES
CO
A B
FC
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108.5 85.6
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/ �W�_W
EXISTING
SEPTIC AREA
1000g SEPTIC TANK: (P) EXISTING
AND DOUBLE CLEAN O�M SEPTIC AREA
COLLAPSED I OOOg SEPTIC TANK (E)
ABANDON PER CODE
DRAIN FIELD (E) 16
�MT
WELL (E)
PANNONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
HENKINS, BLOCK 1, LOT 4
JENNIFER STINER
P.O. BOX 772633
EAGLE RIVER, AK 99577
P HLA nth 10/17/11
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10008 SEPTIC
96,6
TANK (N)
PANNONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
HENKINS, BLOCK 1, LOT 4
JENNIFER STINER
P.O. BOX 772633
EAGLE RIVER, AK 99577
P HLA nth 10/17/11
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1 OF 1
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
rr Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP111126
Tax Code Number: 05129222000
Work Type: Septic Upgrade
Permit Effective Dates: June 27, 2011 to June 26, 2012
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: HENKINS
Site Legal Address: HENKINS BILK 1 LT 4 G:0755
Owner/Address: STINER JENNIFER E
PO BOX 772633 EAGLE RIVER AK 995772633
ent S
1:. epaj tjai ent
Site Mailing Address: 16207 OLD GLENN HWY, Chugiak Lot Size in Sq Ft: 21344
Total Bedrooms: 3
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
�L.
Received By: r' "
Issued By:
Date: is
127111
MUNICIPALITY OF
Community Development Department
DevelODIleft Services DMsion
On -Site Water & Wastewater Program
Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0G_/-ZqZ--ZZ_
Naimoli-=
Property owner(s) -,TCA1NiF6jr, s-rj*ER Day phone
Mailing address F'0.
Site address I (*-zq7 6,-0 6_L.,--1vA) 14tj
Legal description (Sub'd., Block& Lot) BL -&l 4-&Tq
Legal description (Township, Range & Section)
Lot Size _Z 341q —Sq. Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
THIS APPLICATION IS AN:
(S all that apply)
Absorption Field
F
Initial El
Septic Tank
9-
Upgrade
Holding Tank
El
Renewal ❑
Privy
0
Private Well
R
Water Storage
El
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Sign
property owner or authorized agent)
Permit/RushFees:,_-'k—
-5—ateof Payment:
Receipt Number:
Permit No. C:6e
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GABui1ding\0n SiteTorms\Client FormsTermit App_01 041 1.doc (Rev. 1/11)
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panensak.com
June 21, 2011
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
Anchorage, Alaska 99519
Subject: Henkins S/D, Block 1, Lot 4
Emergency Septic Tank Replacement Permit Request
Ladies and Gentlemen:
I am writing to request that a permit to install a new 1000 gallon Septic tank be issued for this
lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is
developed. The existing septic system was designed and installed for a three-bedroom house and
is operating adequately for three bedrooms. The existing steel 1000 gallon tank is collapsed. The
damaged tank is exposing the raw sewage to the environment. The existing tank will be
abandoned per code. The clean out at the end of the existing drain field is separated and will be
repaired. The surrounding lots are served by private wells, and there are no wells within 100 feet
of the proposed septic tank. This lot is served by public water as well. PES will verify all
required separation distances at time of installation.
1. Upgrade Tank Design.
a. See Sheet 1 of 1 of the plan set
2. Surface Water: There is no surface water within 100 feet of the proposed system. The
proposed systems will maintain at least 100 feet from all surface water and drainage ditches.
3. Topography: Lot 4 slopes from west to east at approximately 2% in the area of the tank
replacement. The proposed installation will be located in the southern portion of the lot next to
the existing septic tank and absorption system.
Milling: P,O, Boy: 1.00217, Anchorage, AK 99510 02 17
M.
P,hys<caL 61.5 Easy 82" Ave, C Ljite B6, Anchorage, AIS 99503
Telephone: (9 07) 272-8218 FAX: (907) 272-8211
Page 2 of 2
The proposed installation will not affect the future development of the surrounding or existing
lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you
have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Attachments:
0ailing� P,O, Box 1.002.1.7, Anchorage, AK, 99510 021.7
Physical: 615 East. 82",:; Ave, Cuite B6, Anchorage, AK, 99503
Telephone: (907) 272-821.8 FAX: (907) 272-821.1
WELL (E)
Cb
_—AA 1
M WELL (E) \ \�
\ � 1
WELL (E) D/W
\ W
W—_ w
EXISTING
\l� /1 .IIA SEPTIC AREA
I
w�— w-�w�ss
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M NO WELLS OR WELL (E)
\/SEPTICS
a
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G z
U
N
/ / 1000g SEPTIC TANK (P)
\ / AND DOUBLE CLEAN OUT M EXISTING
i / SEPTIC AREA
Ss COLLAPSED 1000g SEPTIC TANK (E)
ABANDON PER CODE
16 DRAIN FIELD (E)
4\5
W
NOTES:
PAMONE ENG SVC, C UIC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
_+SOF q \`
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Steven R. annone
(r �F . CE 8149 j
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Aw
,,ll`��1�?OFESSIONP�
Date
6/21/11
EMERGENCY REPLACEMENT
Scale
1"=50,
HENKINS, BLOCK 1, LOT 4
JENNIFER STINER
P.O. BOX 772633
EAGLE RIVER, AK 99577
P.I.D. NO
051-292-22
PERMIT NO.
XXXXXXXXX
PLAN
Sheet
1 OF 1
MUNICIPALITY OF ANCHORAGE �e_
nrr— �—Piw /o-'
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
V
,-E77J64TTJ
ENVIRONMENTAL ENGINEERING DIVISION ���tJl�-[
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
p
/���J} 1 9/ AOI
Y r / #-��t✓�� LIIL�� /LI �-�
PHONE
(TJ�� �ZJ�
❑NEW
1PGRADE
MAILING
ADDRESSOf3a a
�
pp
&X. �LIVG
LEGAL DESCRIPTION
LOCATION
NO. OF BEDROOMS
nl' �� ,4��f-c If, P,�g
3
C7
DISTANCE TO:
Well f
!�'
Absorption area
:7
Dwell in If
PERMIT ,(4o. 7
Y
w Q
Manufacturer /J �A
Material
No. of co�]artments
G
N
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
6 Y
JUz
DISTANCE TO:
Well t �L.s
Dwelling r�
PERMIT NO.
= Z H
Manufacturer
Material
Liquid capacity in gallons
O
-�M
w
DISTANCE TO:
Well
Foundatio /
Nearest lot ling
PER IT NO.
/40
J LL Z
Z w
I'—OC
No. of lines
l
Length of a ch 'ne
Total length of Innes
/
Trench wid
inches
Distance between Ines
¢ F
Top of tile to finish grade
Material beneath tile
Total effeQ�ive absor tion area
�/O
0
&0
�v inches
Length
Width
Depth
PERMIT NO.
Lu
0
aF
Type of crib
Crib diameter
Crib depth
Total effective absorption area
Wa
WWell
to
Building foundation
Nearest lot line
DISTANCE TO:
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
Building foundation
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
OTHER
PIPE N�A-10
_190eI-�A_Leo
ze
SOI L TEST RATING /
INSTALLER
REMARKS
9
1r. F
o
APPRO
DATE LEGAL
\ 4/
l
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT; BR>= 136
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
C-4 HE F=�-r " -1 1 -0 1 F7 V-4 s:3 -r " 4- -1 13FRIzlVal C-- F= F�-F-
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
F, E= 479 U I F-:: FEE r,- _F. FE F=� -r 3: 0- -r F:l V-4 t--: S 17E= (D C-5 ID 0n9_1_ 0
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCE'S, THAT THE WELL WILL SERVE.
--- -rWI7-u < :2 > F=IF,"E: F,:E:C-!UlFR. aE:o — — —
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM is
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F=oE-=F;l'Ml-r 0,E:lZE"ME-E-14Z 2:1, -1 ID
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
M. 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED:-- ----------------
APPLICANT H OLD JURGUNSEN
ISSUED BY ------ -DATE- y 1-d V4.0
"U"IC:,�lFo'ni I -FV OF= n"C-U-�QF--Fl0F=
DEPARTMENT i' , HEALTH
AND ENVIRONMENTAL' �OTECTION
825 'L' STREET,
ANCHORAGE,
AK 99501
264-4720
1 -FF=
FE LJ FEE F;'.'
Fzo r=- F2.M I _r
PERMIT
NO. '80016-7 )
APPLICANT
HAROLD JURGUNSEN
PO BOX 1282
E. R. 99577 688-2385
LOCATION
LEGAL
L4 B1 HENKINS S/D
LOT SIZE 20800 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT; BR>= 136
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
C-4 HE F=�-r " -1 1 -0 1 F7 V-4 s:3 -r " 4- -1 13FRIzlVal C-- F= F�-F-
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
F, E= 479 U I F-:: FEE r,- _F. FE F=� -r 3: 0- -r F:l V-4 t--: S 17E= (D C-5 ID 0n9_1_ 0
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCE'S, THAT THE WELL WILL SERVE.
--- -rWI7-u < :2 > F=IF,"E: F,:E:C-!UlFR. aE:o — — —
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM is
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F=oE-=F;l'Ml-r 0,E:lZE"ME-E-14Z 2:1, -1 ID
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
M. 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED:-- ----------------
APPLICANT H OLD JURGUNSEN
ISSUED BY ------ -DATE- y 1-d V4.0
r O & E ENG114EERING & DEVELOF ovIENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774
Performed for: Name: "I
Mailing Add
.Legal Description: 'a7
.Depth
,Depth (feet)
0
1
2
3
4
SOIL LOG
Soil Characteristics
144 �i6rjd / 94aJLZ
F75
ef(!c= lZc1 Lots c; f 7o
e kj � oy �e� 1� 1
7,--m d'��
4F-iev 170 a- -
-1 - 10 -�—
Earl Ellis
688-2280
Tel. No. &OR -0
PLOT PLAN
11
T'
12
,t
j'
PERC. TEST
13
V�
„�
�-2��ac4�za c�".QrE � i2sstix/�.r✓cC.�
14
15
/
��r%r�m o� C VI.-
yy I ©
15
Ground Water Encountered: Yes
NoP'Uifzypv✓hat depth
Proposed Installation: Seepage Pit- Drain Field ✓
Comments: Ayre--� e -,,c-
--'31,
i�
'' �ae'y ���°-moi ��� �.'oAJ
/ A.- ,.-fid :X -
Performed by: �C� �,� �T Date:�� �9�®
. .
~ ^ MUNICIPALITY OF ANCHORAGE
Department o( Health & Human Services
825 L Street, AnchorageAlaska 99501 343-4�f��
ON. - SITE WELL PERMIT '
Permit Number: 890180 Upgrade
Date Issued: 08/25/89
Owner Name: HAROLD JURGENSEN Day Phone:
Owner Address: 16207 OLD GLENN HWY^ 688^2385
EAGLE RIVER, AK 99567
Parcel Id: 4�, 292�22
Lot Legal: Subdivision: HENKING Lot: 4 Block: 1
Section: 30 Township: 151 Range: 1W
Lot. Size 21344 (sq.ft, or acres) '
Max Bedrooms: This Permit: 0 Total Capacity: 3
WELL: Log must be submitted to Municipality o{ Anchorage !Myna rhnent o{ Health
and Human Services within 30 days oK well compleiion^ '
WELL TO BE INSTALLED PER ENGINEERS ATTACHED DRAWIN8, PLEASE
INDICATE WHEN EXISTING WELL WAS ABANDONED WHEN SUBMITTING THE
WELL LOG" THIS PERMIT IS ISSUED FOR THE EXISTING 3 BEDROOM
SINGLE FAMlLY HOME ONLY AND EXPIRES ON 12/31/89"
I CERTIFY THAT:
1" I am {amiliar with the requirements |or onsite sewers and wells as set
[orth by the Municipality o� Anchorage (MOA) and the State A Alaska"
it. I will install the system in accordance with all MOA codes and regu1ations,
and in compliance with the design criteria of this permit^
3" I will adhere to all MOA and State of Alaska requirements for the set back
distances {rom any, existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 0 bedrooms. I
aIso understand that the capacity o� the total system is 3 bedrooms and
any enlargement will require an additional permit,
/
Signed: �2 DATE:
(Owner) HAROLD
Issued By: DATE:
/ �
1
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0
{-ANi K
AI(
AS BUILT SURVE4.
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tpaP�°.am e•�aaape9 as p,® I
a� �g ePP°Psoa a°eo. e•eee •o eee •• `�
:p Louis A. Butera • f�� ®® z _,5-4r �6. 39S I
4eA aP CE -6736 � I I
pop •••\V d')9 1
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--
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I I Richard P. Hankins, hereby certify that I hove survoyed the following described property;
UT//VK/VoAnchorage Records, laskaa7
encroachments exist
except as indicated hereon,
C
�E 0'. ,4�q b It is the responsibility of the owner to determine the existence of
�C'2�:' any eosements, covenants, or restrictions which do not appeor on
u the recorded subdivision plat. Under no circumstances should
49I_" i.1 . any data hereon be used for construction or for establishing
boundary or fence lines.
4Hu
f
00
AO
Qp e••
>i "ClIrf S S Ka, Xv a y
%mow
Dole: Drawn by: Nepoie0 by
RICHARD R HANKINS
REGISTERED PROFESSIONA{ LAND SURVEYOR
Scale: Piot filing no: P.O. BOX 1105 • EAGLE RIVER,ALASKA
/'/= 3vP-3637 PH. 694.2371 99577
t39• /G
va
Trrtifirbi3rilliug Ku)
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
OWNER OF LAND d�4040 %iukG1-e r=✓J DEPTH OF WELL
ADDRESS YO_ D .)'; Dx 0 Fcc % STATIC LEVEL OF WATER FT. JT L
LEGAL DESCRIPTION/- a 1 'q t?C k / /7'ti +Jk,i'j-'
DATE - Started Ended _
PERMIT NUMBER
DRAW DOWN FT.
GALS. PER HR /S"a 0
KIND OF CASING 4^ p O4
KIND OF FORMATION:
From
Ft. to
Ft. W 4 1 `-d
From
Ft. to--Ft—
o_Ft.FromFt.
From J Ft. to r� Ft.
C1'9")6
15 t I(.K `1 P
From Ft. to
Ft.
From Ft. to Ft.
�\ r? J 0 61`A0= % t'% ''
From, Ft. to
Ft. ___
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ENVIRONMENTAL PROTECTION
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MUNICIPALITY OF ANCHORAGE
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ENVIRONMENTAL PROTECTION
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DRILLER'S NAME —
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 051-292-22
1. GENERAL INFORMATION
Complete legal description HenkinS, Block 1, Lot 4
Location (site address) 16207 Old Glenn Hwy
r R
Expiration Date: qj 1 �2 - / -1 5
Current Property owner(s) Daniel and Kimberly Crowley Day phone _
Mailing address
Real Estate Agent
133 W Canterbury Dr Wasilla, AK 99654
2. TYPE OF DWELLING:
Q Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
i]
Individual
El
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request
Received by: Date: 5.1130201S
COSA to be released to the engi eer unless otherwise requested by the engineer.
COSA Fee $ 5a (o "
Date of Payment .517116
Receipt Number /► Q (D l�QpT
COSA#
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
_and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at
the time of installation.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend an the local soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the Control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the ownerlisted
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
Date 04/29/2015
I�'A �
6. DSD SIGNATURE " . .. r . """;
System #1 Approved for bedrooms t etre P i ore
System #2 Approved for bedrooms c�'•,
CE
System
Disapproved itOtE55t_+i"
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date: 2—
T unici it f Aorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible. for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheetr%'. 0
If more than 1 septic system is on the lot:
COSA Checklist #_of?
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description:-Hen'k'1`M-,� lock 4 -,Lot 4
"ELIr DATA
Well type Private If A, B, or C provide PWSID #
Date completed 08/1989 Sanitary seal (Y/N) Y
Total depth 81 ft. Cased to 81 ft.
Date of test
Static water level
Well production
FROM WELL LOG
08/1989
55
25
ft.
9.p -m.
Parcel ID:051-292-22
Well Log (Y/N) Y
Wires properly protected (YIN) Y
Casing height (above ground) 12+ in.
AT INSPECTION
04/29/2015
59 ft
4.2 g,p.m.
WATER SAMPLE RESULTS: p
Coliform Pe- colonies/100 mL Nitrate S 1 � mg/L
Arsenic ug/L Date of sample: 04/29/2015 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/ Steel Date installed Q7/29/2011
Tank size 1.000 gal Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (YM) Y Depression over tankp (Y/N) For
High water alarm (Y/N) N
Date of pumping it ZD Pumper v L S I L,f n
C. ABSORPTION FIELD DATA..
Date installed 05/31/1980 Soil rating (g.p.d./ft2 or felbdrm) 136 sgft/bdrm System type DeepTrenCh
Length 41 ft. Width 4 ft. Gravel below pipe
Total depth 9.1 ft. Eff. absorption area 410 fig Monitoring tube Y Depression over field N
Date of adequacy test -04129/2015 Results (Pass/Fail) PASS For 3— bedrooms
Fluid depth in absorption field before test .0 in. Water added 468 gal. New depth 10 in.
Elapsed Time: 220 min. Final fluid depth 0 in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No
Absorption rate >= 450+ g.p.d.
If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in
Datum
Size in gallons Manhole/Access (Y/N)
'Pump off' level at in. High water alarm level at
Cycles tested Meets alarm & circuit requirements?,,
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots -100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer /septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line i 10+ B Id' f ndation 10+
Water Service line 10+
Curtain drain 50+
F. COMMENTS
umg ou
Surface water 100+
Wells on adjacent lots 100+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone
Date 04/29/2015
COSA canary sheet_2.6-15.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 10+
in.
Municipality of Ancht fag. _
• Development Services Department sA
Building Safety Division a
On -Site Water and Wastewater Program SA E7 r
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 01;3.-292-22 COSA #�
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Henkins. Blk3..Lt4
Location (site address) 16207 Old Glen Hwy, Eagle River Ak. 99577
Current Property owner(s) Jennifer E Stiner Day phone
Mailing address P.O. Boxv7263� Eagle River Ak. ggsvv
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services, LLC Phone 272-823.8
Address P.O. Box 100237. Anchorage AK geSio
Engineer's Printed Name Steven R. Pannone, P.E. Date I?z&tZ
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features.
The operational life of all wells and septic systems depend on the local soil condition, ground water
-levels that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of this system. All systems eventually fail and
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for _ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: ! Original Certificate Date:
(Rev. 11/05)
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Henkins BIk2. Lt4 Parcel ID: 052-2g2-22
A. WELL DATA
Well type Private If A, B, or C provide PWSID #_
Date completed 8/28/lq8q Sanitary seal (Y/N) Y_
Total depth 8i ft. Cased to 8o' 61, ft.
FROM WELL LOG
Date of test 8/28/2080
Static water level sc ft.
Well production 25 g.p.m.
WATER SAMPLE RESULTS:
Well Log (Y/N)
Wires properly protected (Y/N) Y
Casing height (above ground) 24, in.
AT INSPECTION
6112/2022
5s ft.
Coliform ALe colonies/100 mL Nitrate _�>19 7 mg//L
Arsenic: *ICI-) ug/1 Date of sample: 4LA IZ Collected by:_Tnels
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Steel Date installed 7/20/2o22
Tank size 2000 gal. Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N) NIA
Date of pumping 7/29/2022 Pumper New Tank Installed
C. ABSORPTION FIELD DATA
Date installed 5/11/108o Soil rating (g.p.d./ftz or felbdrm) 216 ft/bd System type Deep Trench
Length 42 ft. Width A ft. Gravel below pipe 5 ft.
Total depth g ft. Eff. absorption area 4�o ftp Monitoring tube Y Depression over field N
Date of adequacy test 6/22/2012 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test i in. Water added46o gal. New depthi in.
Elapsed Time: loo min. Final fluid depth z in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
"Pump on" level at
Datum
Size in gallons
in. "Pump
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot aoo+
Absorption field on lot aoo+
Public sewer main 75+
Sewer /septic service line zS+
Animal containment areas —ioo+
Manhole/Access(Y/N)
High water alarm level at
Meets alarm
On adjacent lots ioo+
On adjacent lots ioo+
Public sewer manhole/cleanout ioo+
Holding tank ioo+
Manure/animal excrete storage areas aoo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line ;+ Absorption field s+
Water main io+ Water service line io+ Surface water ioo+
Wells on adjacent lots aoo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line io+ Building foundation io+ Water main io+
Water Service line ao+ Surface water aoo+ Driveway, parking/vehicle storage io+
Curtain drain co+ Wells on adjacent lots ioo+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and :"F d,- 'q. ,
review of Municipal records that the above systems are in n
conformance with MOA COSA guidelines in effect on this date. •
• ...
••
%Steven R.Ponnonei
Engineer's Printed Name Steven R. Pannone, P.E. •�jC '• No. ce 81 49 °
C2 �
Date e2®co
COSA Fee $ !�6) o 1
Date of Payment (-Oh S 11 a-1
Receipt Number f?c7 5�1
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
711
3r
MUNICIPALITY OF ANCHORAGE Via,„! „ 4vCfli}t74,;,
° DEPARTMENT OF HEALTH & HUMAN SERVICES !'i,; ` _
Division of Environmental Services �p =% r
On -Site Services Section 7996
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ' S _ , `I ) — �'Z ” HAA # � �'\S r—C
1. GENERAL INFORMATION
Complete legal description fi -.tit %S �.Gr� 4'-s""' - ` if (311 _7 -
Location
Location (site address or directions) / c c"et' C /`-'I.�% /-/'-
C' -� '4/1 �l'!3 '!(%
Property owner �fi + j�. " 'J� L Day phone ,p`2 _ ��? ``
Mailing address b x 7122 3 Eu,ki
Lending agency
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3'%/
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm1?;.>A,• wee—Sox vice t-- Phone -s
Address P.O. Box 773294, Bade River, rAK 99577-3294
Engineer's signature
6. DHHS SIGNATURE
__`L Approved for ���� bedrooms.
M
Disapproved.
Conditional approval for
Additional Comments
Date
bedrooms, with the following stipulations:
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes
and theirlending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
7 . 9 iaov voii Rack MnL n 1
10
Municipality of Anchorage rP,p��`4FRYaJHa
DEPARTMENT OF HEALTH & HUMAN SERVICES_
Environmental Services Division 1998
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907)
ff ii Health Authority Approval Checklist
pi
Legal Description: e.�k 1e95 KrLei 13.E Parcel I.D.: CSS 1 2-
A. WELL DATA
Well type 'y it If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) 5 Date completed
Total depth Cased to `�� �Casing height (above ground) ,S
Sanitary seal (Y/N) Yes Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test 73- 73, 3 A V 9'
Static water level S S
Well production g.p.m. ¢S 3 9 -P.M.
WATER SAMPLE RESULTS:
Coliform Yfi Nitrate s'y`i 5� Other bacteria
Date of sample: 3 — 3 —21Y Collected by: 'F_
B. SEPTIC/HOLDING TANK DATA
Date installed I ?FO
Tank size Number of Compartments )- Cleanouts (Y/N) %5 (1)
Foundation cleanout ON) %e S Depression (Y/N) c' High water alarm (Y/N) /16)
Date of Pumping
'3--3-W6
C. ABSORPTION FIELD DATA
Pumper
Date installed
% ���� Soil rating (g.p.d./ft2 or ft2/bdrm) /36
�r `�, System type
System
//
Length q% s
Width ' Gravel thickness below pipe
S Total depth
i
Effective absorption area ``l /0 Monitoring Tube present (Y1N)_A_L Depression over field (Y/N) I/E7
Date of adequacy test 3--3'- qg Results (Pass/Fail) mss For a bedrooms
Fluid depth in absorption field before test (in.); Immediately after g2Sgal. water added (in.): ��
Fluid depth -,S " (ins) Minutes later: �Absorption rate = .4-115 g.p.d.
Peroxide treatment (past 12 months) (Y/N) IV,1,9 If yes, give date /0
72-026 (Rev. 3/96)'
D. LIFT STATION
Date installed / 14
Manhole/Access (Y/N)
High water alarm
J
E. SEPARATION DISTANCES
Size i
on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
"Pump off" level at*
Septic/holding tank on lot I q1 On adjacent lots �qc
i
Absorption field on lot 5S- On adjacent lots Jor/
Public sewer main zt� Public sewer manhole/cleanout lf,1,4
Sewer /septic service line 6� S Lift station 1VX
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation 93' Property line Z e� Absorption field .57 r
Water main/service line I c7S Surface water/drainage N4 Wells on adjacent lots +fe)"
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line % 7 Building foundation F d Water main/service line +/0
Surface water ,V,4 -"` 14, Driveway, parking/vehicle storage area t fv
Curtain drain N'/i Wells on adjacent lots -f /o« ",
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records' that! the above systems are
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name yr�
Date _G T
#.
HAA Fee $ X) 0 r c) 0
Date of Payment
Receipt Number 5
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
.r'
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D.# Aola_ QQ HAA# tAnS-111D 11a?S
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Henkins Sub., Lot 4 Block 1 T15N, R1W, Sec. 30
Location (address or directions)
16207 Old Glenn Hwy. Chugiak Ak 99567
(b) Property owner Mr. & Mrs . Jurgensen Telephone: (home) 688-2385 Business
Mailing Address 16207 Old Glenn Hwy Chugiak Ak. 99567
(c) Lending Institution 4lk_ Telephone
Mailing Address
(d) Real Estate Company and Agent Great land Realty/Caroline Stre ano-Thomas
Address 11411 Old Glenn Hwy. Eagle River Ak 99577
Telephone 6y4—
(e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-FamilyXI
3. WATER SUPPLY
Individual WeIIKI
Number of bedrooms 3
Commuoity ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site 0 Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of FirmEagle River Engineering Srv. Telephone 694–
Address P.O. Box 773294 Eagle River Ak 99577
Date y-5-
9' q
4
)pl, 1 a VOJ '
;Enginedr's'Seal
6. DHHS APPROVAL
Approved for 3 bsdrooms by Jot1N 5M (n� Date
Approved _ X _—Disapproved Conditional
Terms of Conditional Approval
_k SeE P rrA-e;,H� tMEW10 TM AALc . ?Ar"6S Coc�ic �tica,�
CAUTIONY
The Municipalityof Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY NCHORVEINICIPALITY OF ANCHORAGEMOA
DEPT. & ANCHORAGE(MOA)
ENVIRONME 4 ECTION Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
Ucp �g18,9 343-4744
Legal Description: Ne"'H�yl s'•� L"`
elj�Kl j /Sr .✓ l / L✓ .rte3 0
�`.
t l t.{..i� ,/_ Sl.� (OMt hVCLl/
RECEIVED
A. WELL DATA
a
Well Classification If A, B, C, D.E.C. Approved (Y/N) pfd
Well Log Present (Y/N)Date Completed Yield -2t di°n+ fLos
Total Depth 2/� Cased to ��,6,, Depth of Grouting "�/�
Static Water Level rs Pump Set At
Casing Height Above Ground -2 Sanitary Seal on Casing (Y/N) Y
Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot / `/l
On Adjoining Lots''1470
To Nearest Edge of Absorption Field on Lot /S"S' ; On Adjoining Lots 100
To Nearest Public Sewer Line NIA To Nearest Public Sewer Cleanout/Manhole ^o/A
i
To Nearest Sewer Service Line on Lot =S
Water Sample Collected byFws �^^ee, ; Date T lis
Water Sample Test Results �O�iFprm = (l pV, tra fe = 3,7 —TA
Comments /1/77%a)e - 3, S- —3/�
f>/mP i v e l� �ar�y✓e r/.� cr 6a wa�l��e �( �`a iii o�-t Ca �l� .
B. SEPTIC/HOLDING TANK DATA
Date Installed 19" Size /Overs No. of Compartments �Z
Standpipes (Y/N) Ik Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) %
Depression over Tank (Y/N) Date Last Pumped 4/d'5 Zr-rj.4ef
Pumping/Maintenance Contact on File (Y/N) ;for r✓��
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) "_/�
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well //J To Building Foundation
To Property Line ao To Disposal Field—�
i
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
31/
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design
Date Installed /lPo Length of Field 4sl f
Width of Field `f8 Depth of Field
9/
Gravel Bed Thickness S�
Tp -e. e, 11,
Square Feet of Absortion Area ylo Statndpipes Present (Y/N) Y
Depression over Field (Y/N) Date of Last Adequacy Test s
Results of Last Adequacy Test Sa 7t, J' 7
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well �`� To Property Line
To Building Foundation To Existing or Abandoned System on
Lot !!5s� �o �' ; On Adjoining Lots
To Water Main/Service Line '`�� To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test.
"Check Permitted Bedroom Rating Against HAA Request"
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines,in:effe.ct on th@date of this
inspection. r� -
F�
Signed A/C
Eagle River Engineering Services fr
Company P. 0 Box 778294 Engineer's Seal
Eagle River, AK 99577 �
Date
( a '+
MOA No. ST `a16 4,
( FP
Receipt No. Receipt No.
Date of Payment Waiver Fee: $
Amount: $ 4 10.L�rJ Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
TO ALL PARTIES CONCERNED:
All concerned panties ar-e advised that the=ubJect Health
Authority Approval HA-cii( 328' for Lot 41 E,lock: i Hen[ -.:ins
Subdivision is being appr-oved based on the fact that a new we]1
was con=trticted to replace an existing well whi,=h was tested and
confirmed to have a nitrate concentration of 9.7 mg/l. The new
wel l has been tested at 3.5 mg/1 nitrate. Since the new wel l is
producing fr-om the sa-,rie aquifer• as the old well a there is a
possibility that nitrate concentrations in the new well ma`.i'
increase abo`e 3.5 mg/1``h-.� The EPA has established 10mg/1 as the
m
maximuconcentrkiort fc- nitrate_ in drinECinq water-.
AU -4
J_�hn Smith. P.E.
J
Pr-ogram Manager, On—site Services
MUNICIPALITY NCHOIuNICIPALITY OF ANCHORAGE (MOA)
DEPT.ENVI ONME t ECTIOIV Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
vcP I9P.9 343-4744
L
Legal Description: IL%"'k�yr Su�,lr it z/
T is / Iw fe . 30
�L� uo'ulor>u 4J -
A. WELL DATA
(d
RECEIVED
Well Classification If A, B, C, D.E.C. Approved (Y//N)
Well Log Present (Y/N) Date Completed F19-'5 Yield -2S
Total Depth Cased to Depth of Grouting AVI.4
Pump Set At
Static Water Level .S -S '
Casing Height Above Ground :2-"
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot / `'II
Sanitary Seal on Casing (Y/N) _-Z
Depression Around Wellhead (Y/N)
On Adjoining Lots""/00
To Nearest Edge of Absorption Field on Lot /SS' ; On Adjoining Lots
To Nearest Public Sewer LineOJ
To Nearest Sewer Service Line on Lot
Water Sample Collected by F^'S'^'eG` ; Date 30
_ To Nearest Public Sewer Cleanout/Manhole ^'IA
eS–
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed y5&1�0 Size /DVDs No. of Compartments
Standpipes (Y/N) y Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Y
Depression over Tank (Y/N) Date Last Pumped � � 1. -rr4cf
Pumping/Maintenance Contact on File (Y/N) ;for ^'/u
Holding Tank High -Water Alarm (Y/N) In/A" Temporary Holding Tank Permit (Y/N) A%
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well To Building Foundation
To Property Line moo' To Disposal Field—�
l
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata J36 #Ieaz Type of System Design
Date Installed ltp__o Length of Field 4'� J
"en., 9 �
Width of Field
Depth of Field
Gravel Bed Thickness S
Square Feet of Absortion Area Z11a Statndpipes Present (Y/N) Y
Depression over Field (Y/N) /7/ Date of Last Adequacy Test
Results of Last Adequacy Test S4 �`'r'`�� 7i'51 ��s"" d "'"� 1115�'el-
SEPARATION DISTANCE FROM ABSORPTION FIELD:
/
To Water -Supply Well J e To Property Line
To Building Foundation �6
Lot Esy, Zo �� ; On Adjoining Lots
To Cutback (if present)
To Water Main/Service Line f/o
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area _z1
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
To Existing or Abandoned System on
7''9z� Z
o'
Dimensions
Manhole/Access (Y/N)
"Check Permitted Bedroom Rating Against HAA Request"
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test.
I certify that I have checked, verified, or
conformed to all MOA and HAA guidelines in,*effec't on thgjdate of this
t
inspection.
6
S t
lo c - X
Signed
Engle River Engineering Services
_
.,.
Company
�A•°� =` "`
Engineer's Seal
Date
Eagle River, AK 99577
G. �.,,....••
"'
MOA No.00
Receipt No. 3� Receipt No. _
Date of Payment k k Waiver Fee: $
Amount: $ 11C fir✓ Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
1. 41 SEWAGE DISPOSAL SYSTEM - APPLICATION 6 PERMIT oe
Nagar of Applicantg•Ajerx Mailing Address 5 Ph. #..
Residence Address �,� Location of Installation 4, 7,_ /I
Legal Description " �
Application to Install: Septic tank Seepage pit Drain field., Other��
To Serve the Following Facility nn
Financed Through To be Installed by fie
Percolation Test Results Anticipated Date of Completion
BELOW TO BE FIL ED OUT BY HEALTH DEPARTMENT5'j��- 3'Ifa 5�F III
This is to serve as;z.8
permit to install a
as described by�5�`' `� ' tr
SizAf unit to be sex+�vc�d�' i f
.� tic tank size Type Seepage Area Type
DIAGRAM OF SYSTEM
DISTANCES:
%
i
' O
i
I
rcaw,fcr.7
li FTlfl rr �'y. -�r ti C h �j
e ell
I • , r?
! f
{
\IV�e
0
r�
Hea h Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough
Ordinance No. 28-68 and that the above described system is in accordance ycith said code.
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
Name `��,, /L'A� ';c�A/ Mailing Address i ,� i, "/) (i cr:'.Ph.#
Location Legal Description
SEPTIC TANK: Distance from well `)Y Material �f l=L Number of compartments��
Liquid capacity (�(>' gallons. Inside length.�wInside width ! Liquid depth
SEEPAGE SYSTEM: Seepage Pit: Number of pits./ Outside diameter or
width , length S , depth, lining material -i Distance from
well, building foundation 61,}I,, nearest lot line -;LL Total effective
absorption area (wall area) ,5 sq, ft.
TILE DRAIN FIELD: Distance from well , foundation , nearest lot line
Total length of lines Number of lines Distance between lines Trench
width in. Total effective absorption area sq. ft. Length of each line
Depth: Top of tile to finish grade Depth of filter material beneath
tile_ in. Above tile
WELL: Type %`1 (lry;, depth �,(� `, distance from building foundation �/ / nearest
s
lot line '�Ll, nearest sewer line )-4 ,septic tank �seepage system
cesspoolother sources
DISTANCES:
A -n _ �-),
i- nTArRAM nr CYCTFM
/ 9
DATE
APPROVED
Health Authority